‘Significant discrepancy’ between radiologists, emergency docs hurting follow-up for incidental findings
Incidental findings are on the rise in radiology, with nearly one-quarter of imaging exams producing masses unrelated to a patient’s initial test. Many health systems, however, struggle with closing the care loop after spotting these potentially cancerous abnormalities.
There are a host of reasons for this, including inconsistent communication between radiologists, ordering providers, emergency physicians, and patients. And new research published Friday in JACR took a look at this problem.
Surveying nearly 400 rads and emergency physicians, most did agree on the importance of incidental masses and the need to follow-up on them, but both physician groups also indicated only a minority of organizations are taking active steps to do so.
In fact, 86% of radiologists said their department has policies or guidelines in place for closing the communication loop on incidental findings; however, only 26% indicated this loop is actually closed and 23% said follow-up is tracked. Emergency providers felt similar: 64% said incidental follow-up tracking doesn't happen and 27% said they were unsure.
So, if radiologists, emergency physicians, and the organizations they work in clearly care about incidental findings, where is the disconnect?
Part of the problem is the “significant discrepancy” between emergency physicians and radiologists regarding who is responsible for arranging and ensuring follow-up.
“Although emergency physicians (EPs) and radiologists agree responsibility for communicating and ensuring follow-up is shared, radiologists assigned more responsibility to the ordering physician, and EPs assigned more responsibility to a primary care physician,” Christopher L. Moore, MD, with Yale School of Medicine’s Department of Emergency Medicine, and colleagues explained in the study.
Their survey stems from a 2019 “Closing the Results Loop on Incidental Findings” grant given to an undisclosed organization (presumably the ACR) to develop a host of quality measures aimed at enhancing incidental finding communication and follow-up.
The 13-minute survey included up to 24 questions for rads and 22 for EPs and ranged from multiple choice to rank order. In total, 247 radiologists and 145 emergency providers from varying organizations completed the web-based survey between May 25 and July 3, 2020.
Plenty of past research has highlighted this deadly incidental finding follow-up problem. One such study analyzed incidental CT findings and found less than 40% of providers adhere to rads’ follow-up guidance, with communication lapses a primary factor.
An editorial covering this topic published in December offered up four imaging-focused management strategies to enhance patient care, including simple verbal reminders.
In wrapping up their piece, Moore et al. noted that both provider specialty groups identify incidental findings as a weak point in patient care that needs to be addressed.
“Despite some difference in perception, these results show a common understanding of IFs as a significant problem with incomplete solutions at this time,” the authors added. “The creation of quality measures that specify accountability and coordination around the follow-up of IFs is both necessary and likely feasible.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.